NPI | 1518357821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW88764) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LCSW88764) |
101YM0800X Counselor, Mental Health | |
104100000X Social Worker | |
Enumeration Date | 2015-01-26 |
Last Update Date | 2022-07-25 |